High-resolution imaging of the spine using multidetector-row computed tomography: differentiation between benign and...

The purpose of this study was to investigate the ability of high-resolution computed tomography (CT) images to distinguish between benign and malignant vertebral compression fractures.

Computed tomography images of 45 benign compression fractures in 40 patients and 33 malignant compression fractures in 33 patients were evaluated. A 16-slice multidetector-row CT scanner was used for data acquisition, and axial images with a slice thickness of 1 mm and sagittal and coronal multiplanar reconstruction images with a slice thickness of 0.7 to 1 mm were used for interpretation.

The following findings were significantly more frequent in malignant fractures: destruction of the anterolateral and/or posterior cortex of the vertebral body, destruction of the cancellous bone of the vertebral body, destruction of the end plate, destruction of the pedicle, a paraspinal soft tissue mass, and an epidural mass. The extremely reliable signs of malignancy were destruction of the anterolateral and/or posterior cortex of vertebral body (100% accuracy) and destruction of the cancellous bone of the vertebral body (97.4% accuracy).

High-resolution CT can provide many useful signs for differentiating between benign and malignant vertebral compression fractures, and its diagnostic ability is sufficient for clinical use.